Ben-Yosef R, Kapp D S
Department of Radiation Oncology, Stanford University School of Medicine, CA 94305.
Int J Hyperthermia. 1993 Nov-Dec;9(6):767-81. doi: 10.3109/02656739309034980.
From May 1981 to September 1991, 38 patients with metastatic malignant melanoma were treated with combined radiation therapy and hyperthermia to a total of 97 hyperthermia treatment fields. Prior treatments to these sites included surgery (31 patients, 76 fields), chemotherapy (18 patients, 54 fields), immunotherapy (14 patients, 42 fields) and radiation therapy (7 patients, 13 hyperthermia fields). Hyperthermia was given to fields located in the head and neck region, trunk and extremities in 30, 45 and 22 cases, respectively. Nodular-diffuse tumours were present in 86 fields while 11 fields were treated for microscopic residual tumour deposits. Concurrent radiation therapy was given in 180-400 cGy per fraction, 2-5 times per week for a mean total dose of 4098 cGy per field. Hyperthermia treatments were delivered using either microwave or ultrasound devices (286 and 48 treatments, respectively) with a mean (range) of 3.4 (1-14) hyperthermia treatments per field for a mean (range) of 43 (10-70) min per field. Patients (n = 34; 84 fields) were available for follow-up for a mean (range) of 14.6 (0.4-82.5) months. At 3 weeks post-treatment, 34 fields had complete, ongoing, or partial responses; 39 fields had no response; and there were no recurrences in the 11 fields treated for microscopic residual disease. Local control was maintained in 31% (26/84) fields with a mean follow-up of 14.6 months. At 36 months, five patients remained alive with complete control of their treated local disease. Statistical analyses revealed that patients with soft tissue metastases only, who were older at the time of hyperthermia, had a longer time between initial diagnosis and hyperthermia treatment, received a higher dose of radiation, had no previous chemotherapy, and had small tumour volumes, had a higher initial response. Multivariate analyses revealed that the three-covariate model including time interval between initial diagnosis and hyperthermia treatment, previous chemotherapy, and metastases to soft tissue only, best predicted response. The results of the investigation support the continued study of combined radiation therapy and hyperthermia treatments for selected patients with metastatic melanoma, and indicate that long-term survival can occasionally be obtained with this approach.
1981年5月至1991年9月，38例转移性恶性黑色素瘤患者接受了放射治疗与热疗联合治疗，共涉及97个热疗治疗区域。这些部位之前接受过的治疗包括手术（31例患者，76个区域）、化疗（18例患者，54个区域）、免疫治疗（14例患者，42个区域）和放射治疗（7例患者，13个热疗区域）。热疗应用于头部和颈部区域、躯干和四肢的区域分别为30例、45例和22例。86个区域为结节 - 弥漫性肿瘤，11个区域针对微小残留肿瘤沉积物进行治疗。同步放射治疗每次分割剂量为180 - 400 cGy，每周2 - 5次，每个区域平均总剂量为4098 cGy。热疗使用微波或超声设备进行（分别为286次和48次治疗），每个区域平均（范围）进行3.4（1 - 14）次热疗，每次热疗平均（范围）持续43（10 - 70）分钟。34例患者（84个区域）可供随访，平均（范围）随访时间为14.6（0.4 - 82.5）个月。治疗后3周时，34个区域有完全缓解、持续缓解或部分缓解；39个区域无缓解；11个针对微小残留病灶治疗的区域无复发。平均随访14.6个月时，26/84个区域维持了局部控制。36个月时，5例患者存活，其治疗的局部病灶得到完全控制。统计分析显示，仅发生软组织转移、热疗时年龄较大、初始诊断与热疗治疗间隔时间较长、接受较高放射剂量、既往未接受化疗且肿瘤体积较小的患者，初始缓解率较高。多因素分析显示，包括初始诊断与热疗治疗间隔时间、既往化疗以及仅发生软组织转移的三协变量模型，对缓解情况的预测效果最佳。该研究结果支持对选定的转移性黑色素瘤患者继续开展放射治疗与热疗联合治疗的研究，并表明采用这种方法偶尔可实现长期生存。
